2025 Sleep Study Billing Services: Key Changes You Must Know

It’s 2025 and billing for sleep studies isn’t getting any easier. However, staying updated on the latest changes today is the ultimate key to managing billing, reimbursement and telehealth efficiently. As new updates to physician payments, CPT codes, and telehealth policies can impact coding accuracy and payments. Thus, keeping up with these changes helps prevent errors, maintain compliance and keep operations running smoothly. 

3 critical updates in billing for sleep study practice in 2025: 

1. New update in Medicare Physician Payment: 

• Medicare’s payment system is changing again in 2025, impacting sleep study billing service. The payment conversion factor has dropped to $32.3465, a 2.83% decrease from 2024. This means lower reimbursements for both attended and unattended sleep studies. The American Academy of Sleep Medicine (AASM) is advocating for better payments and pushing for a new law to increase rates this year. 
•  Another concern is the ongoing push to streamline the prior authorization approval process for sleep studies, particularly for those involving telehealth or home testing. The AASM is actively lobbying for legislation that would expand access to these services. It will also ensure that reimbursement rates align with the growing demand for home-based care. 

2. Recently updated CPT codes: 

Using the right CPT codes is essential for smooth billing. Here are the latest coding updates for this year: 

• G2211: CMS has updated the rules for code G2211. Payment is now allowed even when billed on the same day as preventive care, annual wellness visits, or vaccinations. This change helps somnologists receive reimbursement for these services without payment concerns. 
• CPT code 95800: CPT code 95800 has been flagged as misvalued due to the shift from reusable to disposable equipment in unattended sleep studies. The AASM, along with other groups, is working to update the codes for unattended sleep testing. These updates aim to ensure accurate reporting for modern technologies and various sleep disorders. 
• CPT code 98016: This code has replaced the old G2012 code. It is used for reporting quick consultations or assessments over the phone or through video calls. This update will help simplify billing for brief discussions that may take place before scheduling a full sleep study. 
• Also, the AASM is advocating for further updates to CPT codes to better reflect the complexity of modern sleep medicine. As telehealth continues to grow, code adjustments are being made to ensure fair reimbursement for virtual consultations. Lastly, accurate reporting for equipment used in sleep studies is becoming even more important as more insurance providers scrutinize claims for compliance with updated sleep study billing service standards. 

3. The current change to telehealth policy: 

• CMS has reinstated previous telehealth rules. It will be limiting services to Medicare patients in specific areas, such as rural regions or places with healthcare shortages, unless new laws are passed. The AASM is backing the Telehealth Modernization Act of 2024. This act aims to expand telehealth access for sleep studies in 2025. 
• Audio-only calls are still allowed for Medicare telehealth services. It will make remote consultations and follow-ups for sleep studies more convenient. 
• Additionally, some temporary telehealth flexibilities from the pandemic have expired, affecting how sleep study providers can deliver virtual care. Providers must also follow stricter documentation requirements to ensure reimbursement for telehealth services. 

Staying updated with the 2025 changes in sleep study billing services is essential in today’s fast-evolving landscape. New policies, adjusted reimbursements, and shifting telehealth rules can quickly become overwhelming. Outsourcing billing services in 2025 can be a game-changer for a practice’s financial health. A professional billing service provider knows how to implement the right strategies to ensure smooth billing, improving cash flow and revenue outcomes. Let the experts handle the complexities, so the focus can remain on patient care. Take the first step—outsource your billing services and make a significant impact!